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)0m *JU8UU|0 Environmental Health Department <br /> r 7 --'COUNTY--- <br /> / <br /> Gnmtns, p,nxs here. <br /> MOD'fOr'ng W£U/SO'| Boring Inspection Report <br /> Date: 10/(-7 118 Inspector: CONSTRUCTION <br /> Facility Address:7,.iSA� k-3aAL�A <br /> Well Address: Total Depth:_______. <br /> VV |l#: Drilling Rig Type: <br /> 6oi/ Bohng#� <br /> � Min 2"Annular EHDSeal Verified: [] Yes []No <br /> Drilling Screen Length FromTo: <br /> Driller Onsite: �-------- `—--------- <br /> FDterPack From: To: <br /> Consultant: �-------- �--------' <br /> Bentonite From: �To� <br /> Geologist: �------- ---------- <br /> Grout From: To:__________ <br /> Public Water System Onsite: El Yes []No COMPLETION [] Stove Pipe []Christie Box <br /> Domestic Well Onsite:� [] Yes E]Nu <br /> |fyes, location and distance: height <br /> .Z~.~~..~SAMPLING <br /> ..~ ' <br /> —'—'' <br /> Holding Temperature: Compusnzm CCUPLETiON <br /> op�mds��=" <br /> Method: <br /> Screening Method: <br /> Verified Chain ofCustody: [] Yes []No <br /> SPOILS ( <br /> � <br /> Contamination Noted: [] Yes []No <br /> If yes, spoils storage Location: / 1; <br /> Covered: El Yes []No <br /> |fyes, material: <br /> GROUTING or DESTRUCTICN Total Depth: S=°i <br /> Depth toWater: ----_-/� ��---�c� IF ^� <br /> Grout Material: <br /> Ga <br /> llo �ofGrout Used: MATERIALS/DEVELOP IM ENT <br /> Casing <br /> |nstaUabun OVVe | Destrocdon Blank Feet Screen Feet <br /> Slot Size: <br /> URohng|ns�UadonO���D�m�on <br /> Bags ufCement: <br /> METHOD USED 8agsSand/Grave|: <br /> Type/BrandofBen�oo�e� <br /> LJPressure Grout []OverD�|| <br /> Filter Pack Typa/Size: <br /> � <br /> [] Gravity Ni-fremie []other: Type ofMethod: <br /> Water Cement 471b Water Cem Pnt 94 lb <br /> gallons Bags gallons Bags <br /> Thickest Thinnest 9 Bags Thickest Thinnpst Bags Bentonite/Gement Mix 3% Mix 5% Mix- <br /> 5 10' 2 10 20 2 Bentonite per 94 lb 2.82 4.71 <br /> 1O/16/2U17 <br /> 1868E. Hazelton Avenue I Otuoktun, California 95205 1 T209 468-3420 1 F 2O9484-0138 1 <br />